STORMWATER MANAGEMENT
PERMIT
Fee Paid:
Date Paid:
Permit #:
Conservation Commission
2 Jabish Street • Post Office Box 670
Belchertown, Massachusetts 01007-0670
Telephone: (413) 323-0405
Fax: (413) 323-0411
Approved By:
Approval Date:
(for use by Stormwater Authority
only)
APPLICATION
1. Project/Site Information
Project/Site Name:
Project Street/Location
Assessor’s Map:
Parcel(s):
2
Estimated Area to be Disturbed (ft ):
Total Area of Impervious Surfaces:
(paved, parking, decks, roofs, etc.) (ft2):
Existing
Proposed
____________________
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2. Applicant Information
3. Owner Information (if different from Applicant)
Name:
Name:
Address:
Address:
Telephone:
Telephone:
E-Mail:
E-Mail:
Fax:
Fax:
4. Contractor Information
5. Other Approvals Required (check all that apply)
Name:
□ Conservation Commission (NOI, RDA, etc.)
□ Planning Board (subdivision, special permit, site plan
Address:
Telephone:
review)
E-Mail:
□ Board of Health (well permit, septic permit)
□ DPW (curb cut/driveway permit)
Fax:
6. Certification
I hereby certify that the information contained herein including all attachments is true, accurate and
complete to the best of my knowledge. I grant the Belchertown Conservation Commission permission to
designate Town Board(s) (i.e., Reviewing Board) as its authorized agent(s) for the purpose of reviewing
stormwater submittals and making recommendations on stormwater permit applications within the
designated Board’s expertise. I also grant the Belchertown Conservation Commission other delegated
Reviewing Boards, and their agents permission to enter the property to review this application and make
inspections during and after construction. Further, I agree to pay for the reasonable costs for engineering and
consultant services necessary for the Belchertown Conservation Commission or delegated Reviewing Boards
to review the application.
Applicant’s Signature
Belchertown Department of Public Works
Owner’s Signature
Date
1
Date
Stormwater Management Permit Application
STORMWATER MANAGEMENT
PERMIT APPLICATION
Conservation Commission
2 Jabish Street • Post Office Box 670
Belchertown, Massachusetts 01007-0670
Telephone: (413) 323-0405
Fax: (413) 323-0411
ROUTING SLIP
Per the Town of Belchertown Stormwater Management Bylaw, the Conservation Commission is
designated as the Stormwater Authority. The Stormwater Authority shall administer, implement and
enforce the Bylaw. The Stormwater Authority may also designate Town Boards, including (but not
limited to) the Dept. of public works, Planning Board, Board of Health, and Building Inspections, to
review stormwater submittals and make recommendations on stormwater permit applications within the
designated Board’s (the “Reviewing Board”) expertise. For additional information, refer to Section 4 of
the Bylaw. The Conservation Commission will use this Routing Slip to select additional Reviewing
Boards when necessary and to collect the appropriate signatures for stormwater permitting. Please attach
a copy of this Routing Slip with your Stormwater Management Permit Application.
To be filled out by the Applicant:
Project/Site Name:
Project Street/Location
Applicant Name:
Applicant Mailing Address:
Applicant Telephone:
Applicant E-Mail:
Please do not write below this line. To be filled out by the Stormwater Authority and Reviewing Boards only.
Date of Permit Application:
Date of Stormwater Management Plan:
Department or
Board
Technical
Review
Required
(Y or N)
Application
Administratively
Complete
(Y or N),
Signature and Date
Technical Review
Complete (Y or N),
Signature and Date
Final Recommendation or
Decision
(A, AC, D),
Signature and Date
Public Works
Conservation
Commission
Planning Board
Board of Health
Other:
A = approval; AC = Approval with conditions; D = Disapproval
Attach any applicable conditions to this Routing Slip.
Belchertown Department of Public Works
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Stormwater Management Permit Application
7. Application Requirements
The application to the Belchertown Conservation Commission for a Stormwater Management Permit
must include four (4) copies of the following application materials:
A. For land altering activity involving construction of a single-family dwelling, where “approval is
not required” (ANR), as defined in the Subdivision Control Act, and that disturbs less than 1 acre
of land:
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Completed and signed Stormwater Management Permit Application Form, including
permit application Routing Slip
A list of abutters, certified by the Assessors Office, within 100 feet of the property
line of the site, including property owners in another municipality
Stormwater Management Plan
Payment of the permit application and review fee
Stormwater Management Plan Requirements: (Check items below indicating that you have
provided the following minimum information)
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Contact Information. The name, address, and telephone number of all persons having
a legal interest in the property and the tax reference number and parcel number of the
property or properties affected;
A locus map;
The existing zoning and land use at the site;
The location(s) of existing and proposed easements;
The location of existing and proposed utilities;
The site’s existing & proposed topography. Existing and proposed topographical
contours at 2-foot intervals are required unless the applicant demonstrates that the
proposed activity will meet the requirements of the Belchertown Stormwater
Management Bylaw and Section 7 of the Belchertown Stormwater Management
Regulations (Stormwater Management Criteria) without such information;
Proposed limits of disturbance;
Estimate of the total area expected to be disturbed by excavation, grading or other
construction activities;
A description of the existing site hydrology;
A description & delineation of existing stormwater conveyances, impoundments, and
wetlands on or adjacent to the site or into which stormwater flows;
A description of the proposed management systems for runoff from impervious
surfaces including roofs and driveways and the locations of any foundation drains,
curtain drains, or other site features that serve to collect and convey stormwater and
their outfalls;
Description of erosion and sediment control measures.
Belchertown Department of Public Works
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Stormwater Management Permit Application
B. For all other land altering activity:
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Completed and signed Stormwater Management Permit Application Form, including
permit application Routing Slip
A list of abutters, certified by the Assessors Office, within 100 feet of the property
line of the site, including property owners in another municipality
Stormwater Management Plan
Operation and Maintenance Plan, with Inspection and Maintenance agreement
Payment of the permit application and review fee
Stormwater Management Plan Requirements: (Check items below indicating that you have
provided the following minimum information)
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Contact Information. The name, address, and telephone number of all persons having
a legal interest in the property and the tax reference number and parcel number of the
property or properties affected;
A locus map;
The existing zoning and land use at the site;
The proposed land use;
The location(s) of existing and proposed easements;
The location of existing and proposed utilities;
The site’s existing & proposed topography with contours at 2 foot intervals;
Proposed limits of disturbance;
Estimate of the total area expected to be disturbed by excavation, grading or other
construction activities;
A description of the existing site hydrology;
A description & delineation of existing stormwater conveyances, impoundments, and
wetlands on or adjacent to the site or into which stormwater flows;
A delineation of 100-year flood plains, if applicable;
Habitats mapped by the Massachusetts Natural Heritage & Endangered Species
Program as Endangered, Threatened or of Special Concern, Estimated Habitats of
Rare Wildlife and Certified Vernal Pools, and Priority Habitats of Rare Species
within five hundred (500) feet of any construction activity.
Estimated seasonal high groundwater elevation in areas to be used for stormwater
retention, detention, or infiltration;
The existing and proposed vegetation and ground surfaces with runoff coefficients for
each;
A drainage area map showing pre and post construction watershed boundaries,
drainage area and stormwater flow paths, including municipal drainage system flows;
A description and drawings of all components of the proposed stormwater
management system including:
Belchertown Department of Public Works
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Stormwater Management Permit Application
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All measures for the detention, retention or infiltration of water;
All measures for the protection of water quality;
The structural details for all components of the proposed drainage systems
and stormwater management facilities;
Notes on drawings specifying materials to be used, construction
specifications, and expected hydrology with supporting calculations;
Proposed improvements including location of buildings or other structures,
impervious surfaces, and drainage facilities, if applicable;
Any other information requested by the Stormwater Authority.
Hydrologic and hydraulic design calculations for the pre-development and postdevelopment conditions for the design storms specified in this Regulation. Such
calculations shall include:
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Locations, cross sections, and profiles of all brooks, streams, drainage swales
and their method of stabilization;
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Description of the design storm frequency, intensity and duration;
Time of concentration;
Soil Runoff Curve Number (RCN) based on land use and soil hydrologic
group;
Peak runoff rates and total runoff volumes for each watershed area;
Information on construction measures used to maintain the infiltration
capacity of the soil where any kind of infiltration is proposed;
Infiltration rates, where applicable;
Culvert capacities;
Flow velocities;
Data on the increase in rate and volume of runoff for the specified design
storms, and
Documentation of sources for all computation methods and field test results.
Post-development downstream analysis, if deemed necessary by the Stormwater
Authority;
Soils information from test pits performed at the location of proposed stormwater
management facilities, including soil descriptions, depth to seasonal high
groundwater, depth to bedrock, and infiltration rates. Soils information will be based
on site test pits logged by a Massachusetts Registered Soil Evaluator, a Massachusetts
Registered Sanitarian, or a Massachusetts Registered Professional Engineer;
Landscaping plan describing the woody and herbaceous vegetative stabilization and
management techniques to be used within and adjacent to the stormwater practices;
Drainage patterns and approximate slopes anticipated after major grading activities;
A description of provisions for project phasing;
Erosion and Sediment Control Plan:
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Location and details of erosion and sediment control measures with a
narrative of the construction sequence/phasing of the project, including both
Belchertown Department of Public Works
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Stormwater Management Permit Application
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operation and maintenance for structural and non-structural measures, interim
grading, and material stockpiling areas;
Path and mechanism to divert uncontaminated water around disturbed areas,
to the maximum extent practicable;
Location and description of and implementation schedule for temporary and
permanent seeding, vegetative controls, and other stabilization measures;
A description of construction and waste materials expected to be stored onsite. The Plan shall include a description of controls to reduce pollutants
from these materials, including storage practices to minimize exposure of the
materials to stormwater, and spill prevention and response.
8. Application Submittal, Review, and Approval Procedures
A. Application Submittal: Four (4) copies of an application to the Belchertown Conservation
Commission for a Stormwater Management Permit should be submitted after obtaining a well
permit and septic permit (if applicable), and concurrently with any other land use permit
applications issued by the Conservation Commission or Planning Board, as necessary. A
stormwater management permit must be issued prior to any land altering activity under the
jurisdiction of the Belchertown Stormwater Management Bylaw. The applicant shall provide
written notice to the Town Clerk of the filing of the application and of the date on which it was
filed. Submission of an application should be made to the Belchertown Conservation
Commission, 2 Jabish Street, P.O. Box 670, Belchertown, Massachusetts, 01007-0670.
For more information and copies of the Belchertown Stormwater Bylaw and Regulations, visit
theConservationwebsite:
http://www.belchertown.org/departments/conservation/conservationhome.htm contact LeeAnne
Connolly, Conservation Administrator at: 413-323-0405 or lconnolly@belchertown.org
B. Administrative Review: The Conservation Commission will review the application for
administrative completeness. If the Conservation Commission determines the application to be
incomplete, the Commission will inform the applicant that the application will be denied based
on the determination that the application is administratively incomplete unless the incomplete
items are addressed by a specific date to be determined by the Conservation Commission.
C. Designation of Reviewing Board: The Conservation Commission will designate Town Board(s),
including (but not limited to) the Dept. of Public Works, Planning Board, or Board of Health, as
its authorized agent(s) for the purposes of reviewing and making recommendations on
stormwater management permit applications for projects within that particular Board’s (the
“Reviewing Board”) expertise.
D. Technical Review: The Reviewing Board(s) will review the application and supporting
documents based on the criteria set forth in the Belchertown Stormwater Management Bylaw and
Regulations. The Reviewing Board(s) will notify the Conservation Commission in writing of its
recommendation on a stormwater management permit application.
E. Final Action: The Conservation Commission will take final action within 45 days of the receipt
of an application by the Reviewing Board(s), unless such time is extended by agreement between
the applicant and the Conservation Commission and/or Reviewing Board(s). The Conservation
Commission will render its final action (approval, approval with conditions, or disapproval) in
writing to the applicant based on the recommendation of the Reviewing Board(s).
Belchertown Department of Public Works
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Stormwater Management Permit Application